Anatomic femoral guide

ABSTRACT

An anatomic femoral guide positions bone tunnels corresponding to the AM and PL bundles in ACL repair and reconstruction procedures. A template guide disposed in a surgical field proximate to a surgical member such as a femur or tibia defines a surgical footprint of the resulting bone tunnel. The template includes apertures corresponding to the size of the bone tunnels for the respective (AM or PL) bundles, and allows positioning at the drilling site to identify the size and location of the bone tunnel, as well as the relative distance between tunnels for double bundle procedures. An offset angle in the template provides differing orientations of the template apertures for visualizing the actual bone tunnel placement. The template has an aperture positionable parallel to a tibial plateau formation on the tibia, and the template orients a second aperture angled by the offset angle for positioning the second tunnel.

BACKGROUND

Reconstructive bone and ligament surgery often involves drilling intoskeletal members to attach connective elements such as ligament andtendon grafts, as well as various artificial replacements and/orattachments for articulated joints. In particular, reconstructivesurgery involving the anterior cruciate ligament (ACL) is becomingparticularly significant because the effectiveness of reconstruction canhave a profound effect on the subsequent physical abilities of thepatient. For professional athletes, for example, an effective ACL repaircan salvage an otherwise career ending injury.

Similarly, an improperly treated ACL injury can be a permanent detrimentfor even everyday mobility.

Surgical procedures for reconstructing ambulatory joints, such as an ACLor PCL (Posterior Cruciate Ligament), often involve drilling bonetunnels through the femur and/or tibia. In such a procedure, althoughthe ACL is typically referred to as a single ligament, it consists oftwo functional bundles, named for attachment points on the tibia. Ananteromedial (AM) bundle is located more anterior (towards the front)and medial (towards the inside) of the tibia. A posterolateral (PL)bundle connects most posterior (towards the back) and lateral (towardsthe outside) of the tibia. Reconstructive procedures may be singlebundle, directed at replacing/reconstructing one bundle or may be adouble bundle procedure, focused on replacing/reconstructing both the AMand PL bundle. Each bundle requires a respective bone tunnel to bedrilled in the femur.

SUMMARY

An anatomic femoral guide positions bone tunnels corresponding to the AMand PL bundles in ACL repair and reconstruction procedures. A templateguide disposed in a surgical field proximate to a surgical member suchas a femur or tibia defines a surgical footprint of the resulting bonetunnel. The template includes apertures corresponding to the size of thebone tunnels for the respective (AM or PL) bundles, and allowspositioning at the drilling site to identify the size and location ofthe bone tunnel, as well as the relative distance between tunnels fordouble bundle procedures. An offset, or insertion, angle in theflattened template provides differing orientations of the templateapertures for visualizing the actual bone tunnel placement. The templatehas a first aperture positionable parallel to a tibial plateau formationon the tibia, and the template orients the second aperture angled by theoffset angle for positioning the second tunnel. The tibial plateau is aflattened region on the tibia opposed to the femur and is a typicalanatomical reference employed in reconstructive procedures. The templatehas variations of aperture size and placement for defining differentsized bundles and aperture spacing for defining a bone bridge betweenmultiple tunnels.

Configurations herein are based, in part, on the observation thatconventional arrangements for anatomic femoral placement of singletunnel and double tunnel locations require surgical techniques andmeasurements based on landmarks that may not be easy to reference. In asurgical field such as the joint area between the tibia and femur, tightclearances between bone and other tissue members tends to limitvisibility and manipulative capabilities of a surgical guide for bonetunnel placement. Unfortunately, therefore, conventional techniquessuffer from the shortcoming that it is difficult to identify the sizeand location of a femoral bone tunnel because drilling guides for ACLrepair are difficult to position and do not allow visualization of thediameter and exit point of a resulting bone tunnel. Conventionalprocedures employ measuring objects and skill to assess the correctanatomic placement.

Configurations herein substantially overcome the above describedshortcomings by employing a guide template (template) that allows thesurgeon to visualize the anatomic footprint of the ACL and approximatethe size of the resulting bone tunnel. The template has a flattened, lowprofile construction which allows positioning parallel to the tibialplateau for identifying the optimal location of the bone tunnel. Thetemplate therefore references the tibial plateau by taking a parallelorientation visible by inspection due to the flattened, planar structureof the template which is thin enough to maintain visualization of theanatomy. For a double bundle approach, the flattened template bends 15degrees to define an insertion angle for the PL bone tunnel (secondaperture in the template). As is known in the art, the double bundleapproach purports to reconstruct the AM and PL bundles to originalattachment points, while single bundle strives to attach to pointsbetween the former bundles. The procedure employed is based on a numberof medical factors as determined by the surgeon. The disclosed guide maybe employed in both so-called “outside in” or “inside out” surgicaltechniques. For the outside in approach, angled insertion members alsoensure divergent tunnels.

The template guide system locates the anatomic femoral footprint of theACL, for identifying hole location for the bone tunnel, double & singlebundle placement, and also accommodates inside out locate tunnelplacement. The template guide further allows for outside in drilling tomeet anatomical insertion points. The template guide therefore allowsthe surgeon to see the anatomic footprint of the ACL and approximate itssize, and provides a method to visualize the tunnels prior to actuallydrilling for both single and double bundle and for left and right knees.A pivoting linkage between the first and second (AM and PL) insertionmembers, or “bullets,” permits a common device to be employed for bothsides.

In a particular illustrated configuration, the anatomic femoral guide isa surgical drilling guide comprising a housing having a sleeve disposedthrough an aperture for maintaining slideable communication with aninsertion member, in which the insertion member is generally elongatedand has an aimer tip and an insertion knob for disposing the insertionmember slideably through the housing along an insertion axis into thesurgical field. An aimer arm engages a slot in the housing for arcuatemovement thereto, in which the aimer arm has a proximate end engagingthe slot and an opposed distal end, such that an aimer guide couples tothe distal end of the aimer arm, and the aimer arm extends in anintersecting manner with the insertion axis. A template attaches to theaimer guide, in which the template has at least a first aperturedefining a drilling footprint, such that the drilling footprint islocated on the insertion axis and corresponds to a bone tunnel throughwhich a surgical attachment is passed.

In a double bundle approach, the surgical drilling guide comprises ahousing having a first sleeve and a second sleeve, and first and secondinsertion members in slideable communication with the first and secondsleeves, respectively, such that the insertion members are disposed at apredetermined angle defined by the sleeves, and the insertion memberseach define an insertion axis and adapted for ratcheting movementtowards a drilling site of a surgical member, typically a femur. Theaimer arm has a proximate end slideably engaging a slot in the housing,such that the aimer arm defines an arc for arcuate movement relative tothe housing. The aimer guide is removably attached to a distal end ofthe aimer arm, via a hinge and set screw, and the aimer guide extendstoward the insertion axes defined by the insertion members. The templateintegrates at a distal end of the aimer guide, in which the template hasa first aperture and a second aperture through a flattened surface inthe template, such that each aperture defines a drilling footprint ofthe respective first and second insertion members. The drillingfootprint therefore defines a size and location of first and second bonetunnels corresponding to the first and second insertion members,respectively, in which the flattened surface has an insertion (offset)angle between the first and second apertures for defining a relationbetween the first and second bone tunnels, such that the first apertureadapted for parallel alignment with a surgical landmark such as thetibial plateau.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing and other objects, features and advantages of theinvention will be apparent from the following description of particularembodiments of the invention, as illustrated in the accompanyingdrawings in which like reference characters refer to the same partsthroughout the different views. The drawings are not necessarily toscale, emphasis instead being placed upon illustrating the principles ofthe invention.

FIG. 1 shows a perspective view of the anatomic femoral guide device asdisclosed herein;

FIG. 2 shows a double bundle configuration of the anatomic femoral guideof FIG. 1;

FIG. 3 shows the template of FIG. 2 deployed at a surgical site;

FIGS. 4 and 5 depict a flowchart of an example femora tunnel placementprocedure using a particular configuration;

FIG. 6 shows a configuration employing a pivot connection between thefirst and second insertion member sleeves;

FIG. 7 shows a detail view of the pivot connection of FIG. 6; and

FIG. 8 shows an alternate configuration of a double bundle device as inFIG. 2 having an arced arm.

DETAILED DESCRIPTION

Disclosed below is an example configuration and deployment of theAnatomic Femoral Guide device for providing positioning and aiming for asurgical drilling operation. In an example arrangement, an ACL repairemploying the guide device for femoral drilling is shown. Alternateconfigurations may employ placement on other skeletal structures, or onsofter tissue surfaces, and may or may not employ a drilling approachfor excavating the insertion tunnel for a guidewire.

The Anatomic Femoral Guide device (device) assists with anatomic femoralplacement of single and double tunnel locations for surgical proceduressuch as ACL anterior cruciate ligament (ACL) and posterior cruciateligament (PCL) repair. During such surgical procedures, accurateplacement of the tunnels helps ensure effectiveness of the repair.Surgical techniques for locating the tunnels often employ measurementsfrom landmarks that may not be easy to reference. Conventionalapproaches employ external measuring templates and skill to assess thecorrect anatomic placement of the tunnels.

The proposed approach depicts a low profile aimer which disposes a guidearm having an aimer template at a placement location of a surgical site.The template has one or more guide apertures (holes) defining placementof the tunnels, and is disposed at the placement location. Generally thetemplate includes one or two guide apertures for single or double tunnelprocedures, respectively. In contrast to conventional approaches, thetemplate allows visualization of the size and location of the tunnels atthe surgical site (the so-called “footprint” of the tunnels), anddifferent sized templates are interchangeable with the guide arm foridentifying an appropriate size. The guide apertures determine the pathof an insertion guide (or “bullet”) having a tip, which penetrates ormarks the drilling location by advancement of the insertion guidethrough a corresponding guide aperture in the template. The templatefacilitates alignment with the tibial plateau, an anatomical featureoften employed for locating the tunnels. In the case of a two tunnelapproach, the template includes a second guide aperture in an angularrelation to the first, such that the angle defines an appropriate oroptimal orientation of the second tunnel relative to the first tunneldefined by the tibial plateau. In practice, a surgeon disposes thetemplate such that the first guide aperture is parallel just above thetibial plateau, and the footprint of the second guide aperture definesthe footprint of the second tunnel based on the angular relation of theguide apertures on the template. Therefore, the template defines 1) thenumber and size of tunnels, and 2), an angular relation of the footprintof the second hole to the tibial plateau (first hole), for the twotunnel approach. In practice, an angular relation of 15 degrees has beenwidely accepted by surgeons performing the two tunnel approach.

In an example arrangement, the template is a low profile aimer guidethat can be used with or without a handle, or “director” supporting theaimer guide. For the inside out procedure, access may be obtainedthrough a medial portal of the knee. The correct spaced and sized singleor double bundle guide is chosen, based on the intended graft size. Inan inside out procedure, a pin is placed in the center of the hole orholes. For an outside in approach the correct aimer guide arm is chosenand attached to the director guide with the correct offset bulletadapter.

The insertion guides emanate from an arm or handle orienting theinsertion guides along an axis through the respective guide apertures inthe template. The insertion guides are movable along the axis topenetrate or mark the surgical site at the placement location defined bythe template. The handle retains the insertion guides in slideablecommunication for axial movement, and multiple guides may be retained ina housing, which may also allow one of the insertion guides to pivotaround the other while each guide axis remains focused on the placementlocation defined by the template. In this manner, a surgeon disposes theguide arm to position the template at the placement location, andorients the insertion guides for optimal placement of multiple (double)insertion guides by pivoting one insertion guide around the other whilemaintaining each along the axis defined by (through) the respectiveguide apertures. The housing has a bore for each insertion guide,defining a relative angle to each other and providing for divergenttunnels. Divergent tunnels are therefore assured, as well as aconsistent bone bridge defined by the distance between the guideapertures.

FIG. 1 shows a perspective view of the anatomic femoral guide device asdisclosed herein. Referring to FIG. 1, the guide 100 includes a housing110 having a sleeve 112 disposed through an aperture 114 for retainingan insertion member 120. The insertion member 120, known in the art as a“bullet,” has an aimer tip 122 and an insertion knob 124 for directingan insertion wire 126 to an insertion point at a surgical site, such asa bone tunnel location on a femur or tibia. An aimer arm 130 couples tothe housing 110 at a proximate end 134 via a slot 132 for slidingmovement therein, and may have an arc shape for arcuate movement. Aguide arm 140 having a template 150 couples to a distal end 136 of theaimer arm 130, and may have a hinged connection 142 for rotation of theguide arm 140 and template 150 in the plane defined by the aimer arm 130and insertion member 120. The template 150 includes an aperture 152defining a drilling footprint at the surgical site, thus providing anindication of the diameter and location of a resulting bone tunnel, andthe insertion member 120 defines an insertion axis 146 defining the pathof the bone tunnel through the aperture 152 in the template 150.

FIG. 2 shows a double bundle configuration of the anatomic femoral guide100 of FIG. 1. Referring to FIG. 2, an alternate configuration 100′includes a housing 110 having a plurality of insertion members 120, 121disposed in respective sleeves 112, 113 via apertures 114, 115. A secondinsertion member 121 disposed at a predetermined angle 134 from theinsertion member 120 directs a second insertion wire 127 to a secondaperture 153. In the double bundle configuration 100′, the template 150defines an insertion angle 160 between the apertures 152, 153 resultingfrom an angling of the template 150 about an angular separation 162. Thetemplate 150 has a flattened, planer construction providing a lowprofile allowing for formation of a recognizable insertion angle 160between the planar surface around the respective apertures 152, 153. Aseparation 165 between the apertures 152, 153 defines a bone bridge inthe surgical member that remains between the bone tunnels followingformation. A typical bone bridge is between 3-4 mm, which corresponds toa separation 165 of approximately 2-3 mm.

FIG. 3 shows the template of FIG. 2 deployed at a surgical site 180.Referring to FIGS. 1-3, the guide arm 140 (shown detached from the aimerarm 130) disposed between a femur 182 and tibia 184. The template 150 isa double bundle template such that the apertures 152 and 153 are formedin planar sections 150′, 150″ of the template 150 separated by a ridge186 defining the insertion angle 160. In practice, the apertures 152,153 correspond to tunnels used for reconstructing the AM bundle 170 andPL bundle 172 respectively, by anchoring a replacement ligament, graft,or other reconstructive member at the attachment points 170′, 170″ forthe AM bundle and at 172′, 172″ for the PL bundle. In a healthy kneejoint, the ACL provides stability to the knee, while also allowing fornormal knee movement. The AM bundle 170 is tight when the knee is bentand provides stability in the forward (anterior) direction. The PLbundle 172 is loose when the knee is bent, and allows for rotation ofthe knee. When the knee is straight the two bundles are generallyparallel to each other, however when the knee is bent the two bundlescross each other. Although the two bundles have slightly differentfunctions, the bundles do not work independently, but rather they worktogether to keep the knee stable while still allowing dexterous movementsuch as during sport and exercise activity.

The template 150 is disposed such that the planer section 150′ issubstantially parallel to the tibial plane 190, as shown by dotted lines192. Upon proper placement, the apertures 152, 153 are disposed inrelation defined by the insertion angle 160 that they convey thesurgical footprint (size and location) of the bone tunnel to be formed(drilled) by the insertion members 120, 121. Following placement of thetemplate 150, bone tunnels 192, 193 are formed by the insertion members120, 121 corresponding to the apertures 152, 153.

FIGS. 4 and 5 depict a flowchart of an example of femoral tunnelplacement procedure using a particular configuration. The disclosedsequence depicts only an example of usage of the anatomic femoral guideas disclosed herein; other procedural sequences, options andalternatives may be pursued with the disclosed device. The exampleprocedure depicted attempts a double bundle replacement employing adouble bundle template, and defines method of surgical drilling forattaching a supportive ligament structure. Referring to FIGS. 1-5, atstep 200, an operator (typically a surgeon) disposes, in a surgicalfield 180, a surgical drilling guide 100 including a housing 110 havinga sleeve 112 disposed through an aperture 114 for maintaining slideablecommunication with an insertion member 120, in which the insertionmember is elongated and has an aimer tip 122 and an insertion knob 124for disposing the insertion member 120 slideably through the housing 110along an insertion axis 146.

The surgeon extends an aimer arm 130, as the aimer arm 130 engages aslot 132 in the housing 110 for arcuate movement thereto, in which theaimer arm 130 has a proximate end 134 engaging the slot and an opposeddistal end 136, as depicted at step 201. The surgeon disposes an aimerguide 140 coupled to the distal end 136 of the aimer arm 130, such thatthe aimer arm 130 extends in an intersecting manner with the insertionaxis 146, as shown at step 202. In the example of FIG. 1, the aimer arm130 further comprises a director handle for manipulation by an operator,such that the director handle is for positioning the insertion members120, 120 on an opposed side of a surgical member from the template fordrilling bone tunnels 192, 193 therethrough, such that the handleincludes the aimer arm 130 and housing 110, and further comprising andan aimer arm extension slideably engaging the aimer arm for arcuatemovement therein, as depicted at step 203.

The surgeon positions, adjacent to a surgical member 182 for drilling, atemplate 150 attached to the aimer guide 140, in which the template hasa first aperture 153 defining a drilling footprint on the surgicalmember 182, such that the drilling footprint is located on the insertionaxis 146 and corresponds to a bone tunnel 193 through which a surgicalattachment is passed, as disclosed at step 204. The template 150 definesthe location and size of the bone tunnel 192, 193, as depicted at step205. In the example arrangement, the template 150 has a flattenedconstruction providing a low profile, such that the flattenedconstruction facilitates insertion between surgical members 182, 184 fordisposing the template 150 in parallel alignment with a surgicallandmark 190 for defining a location of the bone tunnel 192, 193, asdepicted at step 206. In a particular procedure, the surgical landmark190 is the tibial plateau and the surgical member 182 is a femur, suchthat the bone tunnels 192, 193 extend through the femur for attachmentof a surgical bundle replacement, as disclosed at step 207.

As indicated above, the template 150 is detachable and has a range ofconfigurations for selecting aperture 152, 153 sizes and the separation165 defining the resulting bone bridge, typically 3-4 mm between thebone tunnels. By way of example, the template apertures 152, 153typically range from 6-10 mm for a single bundle template, and 5/5, 5/6,6/7, 6/8 and 7/8 for the double bundle sizes, however other sizes may beformed. A surgeon will typically select a template 150 duringpreparation for the surgical procedure, however the template 150 isinterchangeable at any time by selecting an aimer guide 140 having theproper template 150 and apertures 152, 153. Accordingly, the surgeon canvisually observe the template 150 in the joint area 180 to verify thesurgical footprint, and at step 208, if the template 150 does not definean appropriate surgical footprint, may detach the aimer guide 140, asshown at step 209, and interchanging the template 150 on the aimer guide140 with one of a plurality of templates 150 having different sizedapertures 152, 153, as disclosed at step 210.

If the procedure is a double bundle procedure, as per the check at step211, then the template 150 further includes a second aperture 153corresponding to a second bone tunnel 193, such that the housing 110 hasa second sleeve 113 for a second insertion member 121, as depicted atstep 212. The second aperture 153 further defines an insertion angle 160formed in the template, such that the insertion angle 160 is formedbetween the first 152 and second 153 apertures for defining locations ofbone tunnels 192, 193 corresponding to the respective apertures, asshown at step 213. The insertion angle 160 is therefore a deviation fromparallel between the apertures 152, 153 for visually gauging andidentifying the footprint of the second bone tunnel 193 relative to thefirst 192, defined by a bend or deformation 186 in the flattened surfaceof the template 150. A complementary angular separation 162 is definedby the closed inner angle of the template 150. Typically the insertionangle is around 15 degrees, however this may change to suit preferencesof the individual surgeon as providing effective feedback and referencefor locating the surgical footprint.

If the housing 110 has a pivoting attachment 111, as depicted at step214, then the procedure may further include rotating a pivot attachment111, in which the pivot attachment is for pivotally engaging a pivotportion of the housing 110 to a fixed plane portion of the housing, suchthat the pivot portion includes the second sleeve 113 and the fixedplane portion includes the first sleeve 112, as the fixed plane portionretains the first insertion member 120 coplanar with the aimer arm 130,as depicted at step 215.

Continuing at step 216, the first aperture 152 is disposed on theinsertion axis 146 defined by the first insertion member 120 in thesurgical joint area 180, and the second aperture 153 is disposed on theinsertion axis defined by the second insertion member 121, such that thefirst and second apertures 152, 153 define a location and diameter of abone tunnel 192, 193 corresponding to the respective insertion member120, 121, as shown at step 216 and in FIG. 3. In the double bundleapproach, the template 150 defines a separation 165 between the firstand second apertures 152, 153, in which the separation is predeterminedand corresponds to a bone bridge 195 between the respective bonetunnels, the bone bridge defining a remaining undrilled distance on thesurgical member 182 between an exit of the bone tunnels 192,193 from thesurgical member, as depicted at step 217 In the example arrangement, theseparation is about 2-3 mm for producing a bone bridge of about 3-4 mmbetween the tunnels 192, 193.

FIG. 6 shows a configuration employing a pivot connection between thefirst and second insertion member sleeves. Referring to FIGS. 1 and 6,pivot attachments 111-1 and 111-2 (111 generally) secure the sleeve 112of insertion member 121 about the axis 146 through which the pivotattachments 111 pass. The portion of the housing 110 securing theinsertion guide 121 is then pivotable about the insertion member 120.

FIG. 7 shows a detail view of the pivot connection of FIG. 6, in whichthe second insertion member 121 pivots around the insertion axis 146defined by the first insertion member 120 by way of the pivotattachments 111 to secure the second insertion member in rotationalcommunication around the sleeve 112 in the housing 110.

FIG. 8 shows an alternate configuration of a double bundle device as inFIG. 2 having an arced arm. Referring to FIGS. 1, 2 and 8, the aimer arm130 has an arcuate shape as in FIG. 1 and engages a slot 132 in thehousing 110 from a proximate end 132 for arcuate movement therein. Thehousing 110 is more elongated than the housing 110 of FIG. 2 because theslot 132 extends further toward the distal end 136 of the arm 130 forproviding guidance and stability to the aimer arm 130 slidably retainedtherein. A hinge 142 secures the aimer guide 140 at the distal end 136for pivoting the template 150 relative to the plane defined by the aimerarm 130 and insertion members 120, 121.

While this invention has been particularly shown and described withreferences to preferred embodiments thereof, it will be understood bythose skilled in the art that various changes in form and details may bemade therein without departing from the spirit and scope of the presentapplication as defined by the appended claims. Such variations areintended to be covered by the scope of this present application. Assuch, the foregoing description of embodiments of the presentapplication is not intended to be limiting, the full scope rather beingconveyed by the appended claims.

1. A surgical drill guide device comprising: a housing having a sleevedisposed through an aperture for maintaining slideable communicationwith an insertion member, the insertion member being elongated andhaving an aimer tip and an insertion knob for disposing the insertionmember slideably through the housing along an insertion axis; an aimerarm engaging a slot in the housing for arcuate movement thereto, theaimer arm having a proximate end engaging the slot and an opposed distalend; an aimer guide coupled to the distal end of the aimer arm, theaimer arm extending in an intersecting manner with the insertion axis;and a template attached to the aimer guide, the template having a firstaperture defining a drilling footprint, the drilling footprint locatedon the insertion axis and corresponding to a bone tunnel through which asurgical attachment is passed.
 2. The device of claim 1 wherein thetemplate defines the location and size of the bone tunnel, the aimerguide being detachable for interchanging a plurality of templates havingdifferent sized apertures.
 3. The device of claim 1 wherein the templatehas a flattened construction providing a low profile, the flattenedconstruction facilitating insertion between surgical members fordisposing the template in parallel alignment with a surgical landmarkfor defining a location of the bone tunnel.
 4. The device of claim 3wherein the template further includes a second aperture corresponding toa second bone tunnel, the housing having a second sleeve for a secondinsertion member, further comprising: an insertion angle formed in thetemplate, the insertion angle formed between the first and secondapertures for defining locations of bone tunnels corresponding to therespective apertures.
 5. The device of claim 4 wherein the firstaperture is disposed on the insertion axis defined by the firstinsertion member, and the second aperture is disposed on the insertionaxis defined by the second insertion member, the first and secondapertures defining a location and diameter of a bone tunnelcorresponding to the respective insertion member.
 6. The device of claim4 wherein the template defines a separation between the first and secondapertures, the separation predetermined and corresponding to a bonebridge between the respective bone tunnels, the bone bridge defining aremaining undrilled distance on the surgical member between an exit ofthe bone tunnels from the surgical member.
 7. The device of claim 3wherein the surgical landmark is the tibial plateau and the surgicalmember is a femur, the bone tunnel extending through the femur forattachment of a surgical bundle replacement.
 8. The device of claim 3wherein the aimer arm further comprises a director handle formanipulation by an operator, the director handle for positioning theinsertion members on an opposed side of a surgical member from thetemplate for drilling bone tunnels therethrough.
 9. The device of claim8 wherein the handle includes the aimer arm, and further comprises andan aimer arm extension slideably engaging the aimer arm for arcuatemovement therein.
 10. The device of claim 4 further comprising a pivotattachment, the pivot attachment for pivotally engaging a pivot portionof the housing to a fixed plane portion of the housing, the pivotportion including the second sleeve and the fixed plane portionincluding the first sleeve, the fixed plane portion retaining the firstinsertion member coplanar with the aimer arm.
 11. A surgical drillingguide comprising: a housing having a first sleeve and a second sleeve; afirst insertion member and a second insertion members in slideablecommunication with the first and second sleeves, respectively, theinsertion members disposed at a predetermined angle defined by thesleeves, the insertion members each defining an insertion axis andadapted for ratcheting movement towards a drilling site of a surgicalmember; an aimer arm having a proximate end slideably engaging a slot inthe housing, the aimer arm defining an arc for arcuate movement relativeto the housing; an aimer guide removable attached to a distal end of theaimer arm, the aimer guide extending toward the insertion axes definedby the insertion members; and a template at a distal end of the aimerguide, the template having a first aperture and a second aperturethrough a flattened surface in the template, each aperture defining adrilling footprint of the respective first and second insertion members,the drilling footprint defining a size and location of first and secondbone tunnels corresponding to the first and second insertion members,respectively, the flattened surface having an insertion angle betweenthe first and second apertures for defining a relation between the firstand second bone tunnels, the first aperture adapted for parallelalignment with a surgical landmark.
 12. The device of claim 11 whereinsurgical landmark is a tibial plateau, the template further comprising aseparation between the first and second apertures, the separationdefining a bone bridge between the resulting bone tunnels, theseparation having a size between 2 and 3 mm.
 13. A method of surgicaldrilling for attaching a supportive ligament structure comprising:disposing, in a surgical field, a surgical drilling guide including ahousing having a sleeve disposed through an aperture for maintainingslideable communication with an insertion member, the insertion memberbeing elongated and having an aimer tip and an insertion knob fordisposing the insertion member slideably through the housing along aninsertion axis; extending an aimer arm, the aimer arm engaging a slot inthe housing for arcuate movement thereto, the aimer arm having aproximate end engaging the slot and an opposed distal end; disposing anaimer guide coupled to the distal end of the aimer arm, the aimer armextending in an intersecting manner with the insertion axis; andpositioning, adjacent to a surgical member for drilling, a templateattached to the aimer guide, the template having a first aperturedefining a drilling footprint on the surgical member, the drillingfootprint located on the insertion axis and corresponding to a bonetunnel through which a surgical attachment is passed.
 14. The method ofclaim 13 wherein the template defines the location and size of the bonetunnel, further comprising: detaching the aimer guide; and interchangingthe template on the aimer guide with one of a plurality of templateshaving different sized apertures.
 15. The method of claim 13 wherein thetemplate has a flattened construction providing a low profile, theflattened construction facilitating insertion between surgical membersfor disposing the template in parallel alignment with a surgicallandmark for defining a location of the bone tunnel; and the templatefurther including a second aperture corresponding to a second bonetunnel, the housing having a second sleeve for a second insertionmember, further comprising: an insertion angle formed in the template,the insertion angle formed between the first and second apertures fordefining locations of bone tunnels corresponding to the respectiveapertures.
 16. The method of claim 15 wherein the first aperture isdisposed on the insertion axis defined by the first insertion member,and the second aperture is disposed on the insertion axis defined by thesecond insertion member, the first and second apertures defining alocation and diameter of a bone tunnel corresponding to the respectiveinsertion member.
 17. The method of claim 15 wherein the templatedefines a separation between the first and second apertures, theseparation predetermined and corresponding to a bone bridge between therespective bone tunnels, the bone bridge defining a remaining undrilleddistance on the surgical member between an exit of the bone tunnels fromthe surgical member.
 18. The method of claim 15 wherein the surgicallandmark is a tibial plateau and the surgical member is a femur, thebone tunnel extending through the femur for attachment of a surgicalbundle replacement.
 19. The method of claim 15 wherein the aimer armfurther comprises a director handle for manipulation by an operator, thedirector handle for positioning the insertion members on an opposed sideof a surgical member from the template for drilling bone tunnelstherethrough, the handle including the aimer arm, and further comprisesand an aimer arm extension slideably engaging the aimer arm for arcuatemovement therein.
 20. The method of claim 15 further comprising rotatinga pivot attachment, the pivot attachment for pivotally engaging a pivotportion of the housing to a fixed plane portion of the housing, thepivot portion including the second sleeve and the fixed plane portionincluding the first sleeve, the fixed plane portion retaining the firstinsertion member coplanar with the aimer arm.